Potassium given instead of bupivicaine for neuraxial ---- wtffffff

Started by coffeebythelake
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Burned_Out said:
I remember pre-filled syringes for CSE injections containing 2mg spinal bupivacaine and 25mcg fentanyl at a few places I've worked at. The rationale was that if you had to give a CSE to a laboring patient, you didn't have too much time to mix up your own drugs. This practice occured as recently as 2023 where I last worked.
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Well all the supposed time cost savings the last 10 years pre filling (5 min per case?) just went out the window with one or two muti million dollar payout.

It may suck if the anesthesiologist even though not to blame gets put on the national practice database. And trust me. You don’t want to be on the database especially if you are planning on doing locums

A few companies (mostly thr smaller) companies will have harder time rating you and may not be able to insurer you (that’s why you see ads “must have clean record” even if it happens 10 plus years ato

Couple of the docs I know and work with explained this to me. So they gotta stick to the major locums companies.
 
aneftp said:
Well all the supposed time cost savings the last 10 years pre filling (5 min per case?) just went out the window with one or two muti million dollar payout.

It may suck if the anesthesiologist even though not to blame gets put on the national practice database. And trust me. You don’t want to be on the database especially if you are planning on doing locums

A few companies (mostly thr smaller) companies will have harder time rating you and may not be able to insurer you (that’s why you see ads “must have clean record” even if it happens 10 plus years ato

Couple of the docs I know and work with explained this to me. So they gotta stick to the major locums companies.
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Yeah. But there would have to be a payout. I would hope the carrier would support defending this one robustly for the individual docs who were clearly set up.
 
BLADEMDA said:
On some days I use 5-7 bottles of mepivacaine for spinal anesthetics. Each patient gets his or her brand new bottle even though I have 27-28 mls remaining in the bottle. I verify the drug, concentration and expiration date for every bottle.
When it comes to spinals we must be extra careful with the drugs we inject intrathecally.
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Why dont you use bupiv .75. They cant wait another hour til the spinal wears off.. Are they that inpatient? If thats the case have the surgery at home.

Plus, I have never had any pharmacy make anything for me that I am injecting neuraxially epidural or spinal. i already dont trust anyone elses drugs. When I take over a case, I throw all the drugs away and draw up drugs myself . that has been my practice for 20 years
 
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aneftp said:
Well all the supposed time cost savings the last 10 years pre filling (5 min per case?) just went out the window with one or two muti million dollar payout.

It may suck if the anesthesiologist even though not to blame gets put on the national practice database. And trust me. You don’t want to be on the database especially if you are planning on doing locums

A few companies (mostly thr smaller) companies will have harder time rating you and may not be able to insurer you (that’s why you see ads “must have clean record” even if it happens 10 plus years ato

Couple of the docs I know and work with explained this to me. So they gotta stick to the major locums companies.
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The anesthesiologist is 1000% getting sued if not already. Who are they gonna name some faceless pharmacy?
 
NPJR said:
Why dont you use bupiv .75. They cant wait another hour til the spinal wears off.. Are they that inpatient? If thats the case have the surgery at home.
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This is idiotic. Mepi is the best for outpt. total joints. An hour (or more) does make a difference when you are tight for beds.
 
NPJR said:
The anesthesiologist is 1000% getting sued if not already. Who are they gonna name some faceless pharmacy?
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There actually is some hope for this doc. There is a trend for plaintiffs attorneys to avoid naming individuals physicians if a larger less sympathetic entity such as a group or hospital can be named, especially if there is a cap. The thinking is a jury is more likely to give a plaintiff verdict if they don’t feel they are having to punish an individual.
 
caligas said:
There actually is some hope for this doc. There is a trend for plaintiffs attorneys to avoid naming individuals physicians if a larger less sympathetic entity such as a group or hospital can be named, especially if there is a cap. The thinking is a jury is more likely to give a plaintiff verdict if they don’t feel they are having to punish an individual.
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lets hope so it’s a global settlement for the hospital only without naming individuals.

Which is different than in cases of tort claims(federal employee) or soveigin immunity (state employee) Those lawsuits will name individuals and they can be reported to the data bank.
 
NPJR said:
The anesthesiologist is 1000% getting sued if not already. Who are they gonna name some faceless pharmacy?
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They sue the deepest pockets. In this case, the hospital corporation. The physicians will also be named, but the corporate hospital deep pockets will be the main target.
They always sue every name on the chart and then the individuals fight to get their names removed from the suit. It will likely be a little while before the suit is actually filed. Lots of investigation has to occur first because the plaintiff attorneys will want to make sure they get every bit of information to make sure nothing is missed. Plus, there are going to be four plaintiffs and they may all have different attorneys or they may decide to collaborate. There are far too many things that need to be found out for this to be filed hastily. It will be a very long and drawn out process. I’m guessing a couple of years minimum. The hospital will want to settle because it will be cheaper for them that way. The medical board will likely also be involved and the plaintiff attorneys will want that work completed. If the medical board finds fault in the physician actions. It makes the plaintiff attorneys job much easier. They can just point that out and they don’t have to repeat the work done by the medical board legal teams. However, medical boards have no jurisdiction over hospitals or business entities. Only individual physician licenses. So the medical board has no mechanism to punish a hospital. But there are other entities that can do that (CMS, Joint Commission, etc.). The plaintiff attorneys will likely allow some of this to play out so they can use the information in their case. Whoever the insurance carrier is may also weigh in. If it is a private equity anesthesia group, they may wish to settle. But their malpractice insurance carrier may choose to fight the case and often, because they are the ones paying the settlement, the physicians may not have a choice. This happened a few years ago in a very high profile case. The insurance carrier went against their clients’ wishes and took it before a jury and lost big time.
Either way, this will be a very big malpractice case, but it will also be very long and drawn out. It will be a nightmare for all involved. Especially the affected patients and their families. The caregivers are all second victims, most of whom did nothing wrong other than trust in the system that was in place. Very tragic story for all involved. The person who made the error is likely a low wage, low education level person who had no idea how costly the error would be. All involved will have a difficult time getting past this. It’s very sad for all. As they say, “There, but for the grace of God, go I.”
 
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Gern Blansten said:
They sue the deepest pockets. In this case, the hospital corporation. The physicians will also be named., but the corporate hospital deep pockets will be the main target.
They always sue every name on the chart and then the individuals fight to get their names removed from the suit. It will likely be a little while before the suit is actually filed. Lots of investigation has to occur first because the plaintiff attorneys will want to make sure they get every bit of information to make sure nothing is missed. Plus, there are going to be four plaintiffs and they may all have different attorneys or they may decide to collaborate. There are far too many things that need to be found out for this to be filed hastily. It will be a very long and drawn out process. I’m guessing a couple of years maximum. The hospital will want to settle because it will be cheaper for them that way. The medical board will likely also be involved and the plaintiff attorneys will want that work completed. If the medical board finds fault in the physician actions. It makes the plaintiff attorneys job much easier. They can just point that out and they don’t have to repeat the work done by the medical board legal teams. However, medical boards have no jurisdiction over hospitals or business entities. Only individual physician licenses. So the medical board has no mechanism to punish a hospital. But there are other entities that can do that (CMS, Joint Commission, etc.). The plaintiff attorneys will likely allow some of this to play out so they can use the information in their case. Whoever the insurance carrier is may also weigh in. If it is a private equity anesthesia group, they may wish to settle. But their malpractice insurance carrier may choose to fight the case and often, because they are the ones paying the settlement, the physicians may not have a choice. This happened a few years ago in a very high profile case. The insurance carrier went against their clients’ wishes and took it before a jury and lost big time.
Either way, this will be a very big malpractice case, but it will also be very long and drawn out. It will be a nightmare for all involved. Especially the affected patients and their families. The caregivers are all second victims, most of whom did nothing wrong other than trust in the system that was in place. Very tragic story for all involved. The person who made the error is likely a low wage, low education level person who had no idea how costly the error would be. All involved will have a difficult time getting past this. It’s very sad for all. As they say, “There, but for the grace of God, go I.”
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Not sure what role the medical board would play. By all indications these docs did nothing wrong at all. Pharmacy fu(ked up big time and drew up the wrong medication and mislabeled it.
 
dannyboy1 said:
Not sure what role the medical board would play. By all indications these docs did nothing wrong at all. Pharmacy fu(ked up big time and drew up the wrong medication and mislabeled it.
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You think it won’t be scrutinized by the medical board? The medical board complaints are likely already in the works. All complaints are looked at carefully. I feel certain that will be part of the process. We don’t know all of the details and the medical board will unlikely rely only on publicly available information.
I suspect the plaintiff attorneys’ early efforts will be to make sure those complaints are filed with the board. They would be foolish not to.
I agree with you that it should not be that way when the fault was upstream from the physicians, but that is how things are done. The attorneys will hit this from multiple angles and use that information to strengthen their case. If the medical board finds no fault, good for the docs but bad for the hospital. Still good for the plaintiff attorneys. If they find fault with the physicians, then it’s very good for the plaintiff attorneys. Now they have the hospital and doctors implicated. In my experience, this is how plaintiff attorneys work. Let the investigating entities do their work (at no cost to the attorneys) and then use that data to shape their case for their clients.
 
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dannyboy1 said:
Not sure what role the medical board would play. By all indications these docs did nothing wrong at all. Pharmacy fu(ked up big time and drew up the wrong medication and mislabeled it.
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The pharmacy board should be coming for the pharmacists involved. The hospital will settle.
Hopefully the docs are viewed as victims trusting the pharmacists (at least by the medical board) but whether malpractice attorneys try to push for liability in delay in recognizing something was amiss sooner (despite the issues that make it hard to tell) will likely determine how ugly it gets for them. I would think none of those involved want to do any spinals there ever again. Which may not be an issue in the short term, as this is such big news that I would guess patients are declining them and some are cancelling their procedures.
 
NPJR said:
So you are admitting that you put the patient at risk because you were tight for beds. You are cold, heartless, money driven and my client deserves the limitis of your malpractice policy if not yourassets.
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1787514275701.gif
 
NPJR said:
So you are admitting that you put the patient at risk because you were tight for beds. You are cold, heartless, money driven and my client deserves the limitis of your malpractice policy if not yourassets.
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I have no idea what you are talking about. Mepi is superior for outpatient total joints and patients laying around waiting for the spinal to wear off is a drag when you need the beds for other patients. You seem sort of deranged!
 
NPJR said:
So you are admitting that you put the patient at risk because you were tight for beds. You are cold, heartless, money driven and my client deserves the limitis of your malpractice policy if not yourassets.
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Normal people use mepi
Why waste resources for people to lay around in beds getting dvts for no reason by using an inferior drug that lasts too long
 
GassYous said:
Normal people use mepi
Why waste resources for people to lay around in beds getting dvts for no reason by using an inferior drug that lasts too long
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It is only inferior depending on what you choose to care about. Block set up time and possibility of block not running out for a slow surgeon or technically difficult total joint? Bupi wins every time.

Avoiding foleys, overflow incontinence, time to ambulation, same day discharge…mepivicaine hands down.

Both have been available for decades.
Mepivicaine is winning currently because we changed the metrics about what we care about.
 
GassYous said:
Normal people use mepi
Why waste resources for people to lay around in beds getting dvts for no reason by using an inferior drug that lasts too long
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Why even use spinals at all? Spinal anesthesia well documented in multi studies have been shown to have LONGER OR TIMES.

But of course they make up crap saying spinals have less 90 day re admissions. We all know anesthesia is only to blame for the first 24-48 hrs max. So the 90 days data is invalid for anesthesia purposes.
 
Lab Lover said:
It is only inferior depending on what you choose to care about. Block set up time and possibility of block not running out for a slow surgeon or technically difficult total joint? Bupi wins every time.

Avoiding foleys, overflow incontinence, time to ambulation, same day discharge…mepivicaine hands down.

Both have been available for decades.
Mepivicaine is winning currently because we changed the metrics about what we care about.
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So metrics can be changed …data rigging to whatever fits the current agenda.
 
I never quite understood the camp that refused to use anything but heavy marcaine for spinals. Yes, it’s the only FDA thing approved for intrathecal IIRC, but other local anesthetics have a long history of being used safely in clinical practice and have multiple studies published using them, including in our own journal, Anesthesiology.

I should mention that most of the people that refuse to use anything but heavy marcaine then also do a bunch of non-evidence based weird nonsense in other areas of their practice.
 
Guillemot said:
I never quite understood the camp that refused to use anything but heavy marcaine for spinals. Yes, it’s the only FDA thing approved for intrathecal IIRC, but other local anesthetics have a long history of being used safely in clinical practice and have multiple studies published using them, including in our own journal, Anesthesiology.

I should mention that most of the people that refuse to use anything but heavy marcaine then also do a bunch of non-evidence based weird nonsense in other areas of their practice.
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There is a different mental hurdle in using something "off label"-and using something that says "not for spinal anesthesia".
 
Anyone with Mepivacaine spinal experience chime in on what their dose is and expected block duration time?

Also, are folks still using 3-chloroprocaine spinals (35-40 mg) for short 45 minute cases?
 
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Burned_Out said:
Anyone with Mepivacaine spinal experience chime in on what their dose is and expected block duration time?

Also, are folks still using 3-chloroprocaine spinals (35-40 mg) for short 45 minute cases?
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40-50mg of Mepivicaine, depending on hip or knee (and surgeon speed), and overall block is 2-3 hours. 1.5 or 2% Mepi, whatever you have available , no additives.

I’ve seen literature recommend 60-68 mg for hips and knees (!) but if the surgeon is that slow might as well tube them.

PT gets to see and work with every patient by end of day , even last case start.

Every orthopedic surgeon I’ve worked with has converted to it exclusively, across 4 hospitals, both PP and hospital employed. It really is a game changer.
 
Burned_Out said:
Anyone with Mepivacaine spinal experience chime in on what their dose is and expected block duration time?

Also, are folks still using 3-chloroprocaine spinals (35-40 mg) for short 45 minute cases?
Click to expand...
From what I remember, 40 mg Mepi up to 2 hours, 50 mg Mepi 2+ hours. I've seen 30-40 mg chloroprocaine used for very short cases. Works well.
 
At least the family understands where the error lies.

“I want to be very clear that this was not the doctor’s fault,” Ms. Dorton’s daughter-in-law, Kristina Buell, told The Tennessean last week. “This was not the anesthesiologist’s fault. This was not the care team’s fault.” She said she had “no reason to believe it could have been an intentional act by a rogue employee.”

When Ms. Dorton woke up after the knee operation, she couldn’t move or feel anything from her sternum down, Ms. Buell told The Tennessean. Doctors in the intensive care unit placed her on a ventilator and drained her spinal fluid to remove the excess potassium, Ms. Buell said. They also gave her a high dose of steroids hoping to reverse the damage, she said.“

www.nytimes.com

Medication Mix-Up Leaves Knee Surgery Patient Paralyzed

A patient was unable to move from the sternum down after a routine knee-replacement operation at a Nashville hospital this month. The hospital said she had been given the wrong anesthetic.
www.nytimes.com www.nytimes.com

 
PF mepi I use 50-60mg and reliably get 90-120 min of anesthesia. The block comes off fast

PF bupi (0.5%) - use 10-12mg and reliably get 2.5-3hrs of anesthesia. Slow onset and slow off ramp. Gentler on hemodynamics generally (not always) and bc of that and duration I use this on all hip fractures.

Some colleagues pushed me on chloropro spinals for cerclage and I hated them. Sacral sparing (which is unfortunate bc all I wanted was sacral). Now I use 1cc of heavy kit bupi.
 
Southpaw said:
PF mepi I use 50-60mg and reliably get 90-120 min of anesthesia. The block comes off fast

PF bupi (0.5%) - use 10-12mg and reliably get 2.5-3hrs of anesthesia. Slow onset and slow off ramp. Gentler on hemodynamics generally (not always) and bc of that and duration I use this on all hip fractures.

Some colleagues pushed me on chloropro spinals for cerclage and I hated them. Sacral sparing (which is unfortunate bc all I wanted was sacral). Now I use 1cc of heavy kit bupi.
Click to expand...

Heavy bupi +/- 15 mcg fentanyl have them sit up for a bit
 
The same anesthesiologist performed the 4 spinals.
6:52 AM (Patient #1): During the first spinal injection, the patient immediately complained of severe burning and pain. The anesthesiologist stopped the injection and the surgery was cancelled, but he dismissed the clinical significance of the reaction, documenting that the patient was "very magnified" and "overly energetic" in their complaints
7:56 AM (Patient #2): Unaware of a medication issue, the anesthesiologist performed the second spinal. When this patient also began complaining of burning pain in her legs, the anesthesiologist simply deepened her sedation to keep her comfortable and proceeded with the surgery
8:05 AM (Patient #3): The anesthesiologist performed the third spinal. This patient also reported pain down her leg that did not resolve, prompting the team to switch to general anesthesia instead of investigating the cause of the pain.
9:28 AM (Patient #4): The anesthesiologist administered the fourth spinal. This patient immediately complained of a burning like "liquid hell," went limp, and went into asystole (cardiac arrest), requiring the surgery to be aborted.

Hard to judge, but it took 4 spinals to figure out something was wrong .
 
According to the hospital's video surveillance and staff interviews:

Pharmacy Technician #1 initially gathered the incorrect vials from the storage bins, scanned them, and placed them into a transport bin.

Pharmacy Technician #2 retrieved the transport bin in the mixing/IV room, withdrew the medication from the Potassium Phosphate vials into the five syringes, and applied the Mepivacaine labels to each syringe.

Pharmacy Technician #3 was present in the mixing room to provide training and oversight for Pharmacy Technician #2, but sat back and observed the withdrawal process without identifying the error.
 
The report also made mention of the anesthesiologist work duties: had been scheduled to work both onsite and on call for Hospital #1 on the following dates:08/17/2026, 08/18/2026, 08/19/2026,08/20/2026, 08/21/2026, 08/22/2026,08/23/2026, 08/25/2026, 08/26/2026,08/27/2026, and 08/28/2026. It also implied there was a lack of rapid intrathecal lavage- indeed these were not instituted for many hours after it was discovered there had been an issue with wrong medication injection, but the discovery did not occur until several hours after the spinals were given, so would it have made a difference?
 
I’m thinking this clinician obviously supervised, did all the first case and flip flop room spinals, didn’t realize what was happening in the PACU, and pushed through. Hate to say it, but I hope I would have done different, don’t know though. They might be hosed either way.
 
Why doesn’t pharmacy pre draw our propofol for busy endo if they are doing this behavior for ortho spine.
They can save on drugs and time.
 
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NumTacos said:
The same anesthesiologist performed the 4 spinals.
6:52 AM (Patient #1): During the first spinal injection, the patient immediately complained of severe burning and pain. The anesthesiologist stopped the injection and the surgery was cancelled, but he dismissed the clinical significance of the reaction, documenting that the patient was "very magnified" and "overly energetic" in their complaints
7:56 AM (Patient #2): Unaware of a medication issue, the anesthesiologist performed the second spinal. When this patient also began complaining of burning pain in her legs, the anesthesiologist simply deepened her sedation to keep her comfortable and proceeded with the surgery
8:05 AM (Patient #3): The anesthesiologist performed the third spinal. This patient also reported pain down her leg that did not resolve, prompting the team to switch to general anesthesia instead of investigating the cause of the pain.
9:28 AM (Patient #4): The anesthesiologist administered the fourth spinal. This patient immediately complained of a burning like "liquid hell," went limp, and went into asystole (cardiac arrest), requiring the surgery to be aborted.

Hard to judge, but it took 4 spinals to figure out something was wrong .
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I also want to know did they cancel all cases at that point? Just for general for everyone? What was the immediate action to prevent further harm
 
Arantius said:
I also want to know did they cancel all cases at that point? Just for general for everyone? What was the immediate action to prevent further harm
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The document doesn’t say, but the report clearly indicates that the incident response wasn’t sufficient to prevent future harm, and that CMS rejected three different
“Immediate Jeopardy Removal Plans” plans by the hospital. It also indicates that there were some serious concerns about one of the Pharmacy technicians, specifically pharmacy technician number two.
 
Aether2000 said:
The report also made mention of the anesthesiologist work duties: had been scheduled to work both onsite and on call for Hospital #1 on the following dates:08/17/2026, 08/18/2026, 08/19/2026,08/20/2026, 08/21/2026, 08/22/2026,08/23/2026, 08/25/2026, 08/26/2026,08/27/2026, and 08/28/2026. It also implied there was a lack of rapid intrathecal lavage- indeed these were not instituted for many hours after it was discovered there had been an issue with wrong medication injection, but the discovery did not occur until several hours after the spinals were given, so would it have made a difference?
Click to expand...
So I was reading your reply, and I realized I have never performed an intrathecal lavage. Anyone on here done one? Know how to do one? On the fly no less?
 
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